Request A Kiosk

Weigh-and-Win-Logo copy

Kiosk Request Form
  • Please complete this form to begin the process of getting your own Weigh and Win kiosk. After you complete this form, you will be contacted by a Weigh and Win coordinator to discuss next steps. If you have any questions, please contact Lia Schoepke at (303) 694-8012 or lschoepke@weighandwin.com Thank you!
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  • Contact Person*full name
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  • Name of Organization*
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  • Organization Type*
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  • # of Employees*
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  • Address*Line 1
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  • Address*Line 2
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  • City*
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  • State*select your state
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  • Zip Code*
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  • Phone*XXX-XXX-XXXX
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  • Email*a valid email address
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  • How Did You Hear About Us?*let us know how you heard about us
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  • Organization Logo*used to promote your kiosk locationUpload
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    • Please review the Kiosk Option Guide and choose the kiosk model that best fits your needs.
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    • Select Preferred Kiosk Style*please view link above for explanation of kiosk models
      Stationary Kiosk
      Mobile Kiosk
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    • Comments*anything else you'd like to tell us
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